Exploring the Representation of Various Categories of Concomitants in Clinical Cases – A Retrospective Observational Case Series Study

Key Words:

Concomitants, representation of concomitant, types of concomitants, Boenninghausen’s concept, Boenninghausen’s approach.

Introduction : –

According to the dictionary, the word concomitant means something which accompanies or is connected collaterally at the same time with something else. [1, 2, 3].  In homoeopathy, Boenninghausen observed and illustrated the importance of concomitants in selection of the remedy in the preface of his “Therapeutic Pocket Book”, in his essay on the treatment of Intermittent Fever and in his hexameter explained in the article “Characteristic Value Of The Symptom” under the heading Quibus Auxiliis.

Further, he has given the guidelines about how to elicit the concomitants in a case. Those are symptoms rarely appearing in connection with the leading disease, another sphere of disease than the chief ailment and those which have characteristics of medicines which can be used by generalizing it, though it was not observed before at a particular level. [4, 5, 6 , 7]

Dr. H.A. Roberts in his book, “The Principle And Art Of Cure By Homoeopathy” has given the importance of concomitants and used associated complaints as concomitant as well as concomitant before the actual complaint starts in his demonstrated cases. [8]

Dr. L.D. Dhawale in his book “Principle and Practice of Homoeopathy” mentioned that Boenninghausen has observed concomitants in connection to chief complaints and in the physical general sphere and that was extended by Dr. Boger. If we analyze the cases given in Principle and Practice of Homoeopathy, in various chapters we can see the use of concomitants in various categories, like concomitant with chief complaint, physical general as concomitant and physical general modality as concomitant and general state as concomitant, which gives us the wider array of understanding in the application of the concept of concomitant. [9, 10, 11, 12]

From the above references, it is obvious that there are different ways in which concomitants can be appreciated and used. Concomitants have been used more or less by physicians in limited ways according to their own understanding. Hence, this paper explores different categories of concomitants applied in clinical cases to assist in understanding the possible application of the concept in our clinical practice.

Further, the aim of the study is to identify what further exploration can be done in the area of concomitants so that it will be useful to homoeopathic physician in accurate selection of the simillimum with ease and accuracy.

Material and methods: –

The case series method has been chosen for this observational study and analysis. Data available in cases treated during the period of January, 2020 to September, 2021 have been utilized. Thirty cured or improved cases have been identified from the private clinical practice.

Selected cases were analyzed in terms of representation of concomitants in various categories, dominant miasm and susceptibility, to find out representation of concomitants in possible different ways in clinical practice, to see any correlation of representation of concomitant with miasm and susceptibility and to identify the areas which need further exploration for the betterment of knowledge of the homoeopathic fraternity.

 Result and discussion:

Table 1: – Distribution of cases among various categories of concomitants.

From the analysis of 30 cases, four major categories have been identified. Those are (1) concomitants present along with chief complaints as a component of complete symptom (location, sensation, modality and concomitant-LSMC), (2)  associated complaints as concomitant (3) physical general as a concomitant including concomitant before, at beginning, during, at the end and after menses, leucorrhoea, stool, urination, coition, pollution etc. as well as other physical generals and (4) the general state running with almost all complaints, like complaints since childhood, diathesis and tendencies etc as concomitant.

That shows concomitant in 1^st and 3^rd categories are more prominently present in cases, that is 56.66% and 43.33% respectively. Whereas 2^nd and 4^th category is less represented in cases with 10% and 6.66% respectively. However, their importance in selection of the remedy can’t be overlooked.

 Table 2– Distribution of cases with concomitant among acute and chronic.

Table 3: – Distribution of cases with one concomitant and more than one concomitant.

From the above table it is evident that 70% of cases having more than one concomitant, whereas 30% of cases have one concomitant. Therefore, cases more often present with more than one concomitant. Further analysis of these categories is there in subsequent tables.

Table 4: – Distribution of cases with one concomitant.

From the cases having one concomitant 44.44% of cases have concomitant associated with chief complaints (LSMC), 33.33% of cases have concomitant in physical general category and 22.22% of cases have associated complaints as a concomitant. So, more or less equal distribution of cases among categories except cases with general state as concomitant category is not found in cases having one concomitant.

Table 5: – Distribution of cases with more than one concomitant across different categories or within same category.

It is evident from the above table that more than one concomitant in the same category is prominently present among cases that is 76.19% out of that 56.25% in LSMC category and 43.75% in physical general category, which is having more or less equal representation. In 23.80% cases more than one concomitant includes different categories out of which 40% having combination of LSMC + physical general and 20% each having LSMC + associated complaints, LSMC + general state and physical general + general state.

Table 6: – In concomitants associated with chief complaints as component of complete symptom-LSMC category representation of more than one concomitant in same category.

In concomitants associated with chief complaints as a component of complete symptom-LSMC 66.66% of cases having both mental and physical concomitants in physical complaints followed by 22.22% cases having mental concomitant in physical complaints and 11.11% cases having physical concomitant in physical complaints. So, mental and physical concomitant together is more represented in physical complaints.

Table 7: – In Physical General category representation of more than one concomitant in same category.

In cases with more than one concomitant in same category physical general as concomitant has solely represent itself in form of concomitants of menstruation. In that 57.14% cases have concomitants before and during menses both together and 42.85% cases having more than one concomitant before menses only. So concomitant before menses has more representation in this category.

Table 8: – Dominant miasm and representation of concomitant in cases.

It is evident from the above table that sycotic miams are prominently observed in cases with concomitant that is in 86.66% cases.

Table 9: – Susceptibility and representation of concomitant in case.

Moderate susceptibility has been observed prominently in cases represented with concomitant in 93.33% cases.

CONCLUSION: 

Concomitants present along with the chief complaint as a component of complete symptom and physical general as a concomitant. These two categories are more frequently observed in analysis, and that can be attributed to familiarity of the same to the homoeopathic physicians.

Moreover, in the physical general category, concomitants related to menstruation are more often sited than other possible concomitants in this category, probably due to easy availability of menstruation related concomitants in female patients.

Less represented categories are associated complaints as a concomitant and general state as a concomitant. Their lesser frequency may be due to lack of understanding that these aspects can also be taken as concomitant. Therefore, these lesser represented categories need more attention in case processing and should be carefully noted to get better utility of these in selection of the simillimum.

Moreover, it is also observed that a sizable number of cases presented with more than one concomitant. Hence, it can be explored that when there is more than one concomitant available in a case, which concomitant can be given more value in making totality.

This study also demonstrates that in cases with concomitants, sycotic miasm and moderate susceptibility is more prominent. However, it’s just an observation and no correlation can be stamped without adequate data and analysis and this is also one of the areas to be explored further.

References: –

1. Merriam-Webster.com [Internet]. Available at: https://www.merriam-webster.com/dictionary/concomitant
2. Cambridge Dictionary [Internet]. Available at: https://dictionary.cambridge.org/dictionary/english/concomitant
3. Oxford Learner’s Dictionary [Internet]. Available at: https://www.oxfordlearnersdictionaries.com/definition/english/concomitant_2#:~:text=concomitant-,noun,same%20time%20as%20something%20else
4. Boenninghausen C, original preface. In: Allen TF, editor. Boenninghausen’s Therapeutic Pocket Book. 5^th American edition. New Delhi, B. Jain Publishers (P) Ltd.; 2009. p. viii
5. Roberts HA, Wilson AC. Introduction to the Therapeutic Pocket Book. In: Allen TF, editor. Boenninghausen’s Therapeutic Pocket Book. 5^th American edition. New Delhi, B.Jain Publishers (P) Ltd.; 2009. p. 22
6. Boenninghausen C., contribution to the judgement concerning the characteristic value of symptoms. In: Bradford TL, compiler and Taffel LH translator, The Lesser Writings of C.M.F. Von Boenninghausen, Reprint Edition, New Delhi, B. Jain Publishers (P) Ltd.; 2005. p. 105
7. Boger CM, Preface, In: Boger’s Boenninghausen’s Characteristics and Repertory, Reprint Edition, New Delhi, Indian Books & Periodicals Publishers; 2009.
8. Roberts HA, The chief complaints and the auxiliary symptoms in their relation to the case. In: The Principles and Art of Cure by Homoeopathy. Reprint edition. New Delhi, B. Jain Publishers (P) Ltd.; 2007. p. 96
9. Dhawale ML, Boenninghausen’s Method of Repertorisation. In: Principle and Practice of Homoeopathy Part -1. 4^th Mumbai, Dr. M.L. Dhawale Memorial Trust; 2006. p. 105
10. Dhawale ML, Boenninghausen’s Therapeutic Pocket Book. In: Principle and Practice of Homoeopathy Part -1. 4^th Mumbai, Dr. M.L. Dhawale Memorial Trust; 2006. p. 113
11. Dhawale ML, Boenninghausen’s characteristics and repertory (Boger). In: Principle and Practice of Homoeopathy Part -1. 4^th Mumbai, Dr. M.L. Dhawale Memorial Trust; 2006. p. 157
12. Dhawale ML, Card method of repertorisation (Boger). In: Principle and Practice of Homoeopathy Part -1. 4^th Mumbai, Dr. M.L. Dhawale Memorial Trust; 2006. p. 17